In ICD-10-CM, chapter 4, "Endocrine, nutritional and metabolic diseases (E00-E89)," includes a separate subchapter (block), Diabetes mellitus E08-E13, with the categories:
Prediabetes
The ICD-10-CM is a catalog of diagnosis codes used by medical professionals for medical coding and reporting in health care settings. The Centers for Medicare and Medicaid Services (CMS) maintain the catalog in the U.S. releasing yearly updates.
PREVENTION AND TREATMENT
Nephropathy induced by unspecified drug, medicament or biological substance. N14. 2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM N14.
In secondary nephrotic syndromes, morbidity and mortality are related to the primary disease process (eg, diabetes, lupus, amyloidosis). In diabetic nephropathy, however, the magnitude of proteinuria itself relates directly to mortality.
Diabetic nephropathy is a long-term kidney disease that can affect people with diabetes. It occurs when high blood glucose levels damage how a person's kidneys function. Diabetic nephropathy is a kind of chronic kidney disease (CKD).
E11. 22 states within its code DM with CKD therefore it is a more accurate code than E11. 21 which is just DM with Nephropathy (any kidney condition).
Diabetic nephropathy is a serious complication of type 1 diabetes and type 2 diabetes. It's also called diabetic kidney disease. In the United States, about 1 in 3 people living with diabetes have diabetic nephropathy.
In adults, approximately 30 percent of people with nephrotic syndrome have an underlying medical problem, such as diabetes or lupus; the remaining cases are due to kidney disorders such as minimal change disease, focal segmental glomerulosclerosis (FSGS), or membranous nephropathy.
What is diabetic nephropathy? Nephropathy is the deterioration of kidney function. The final stage of nephropathy is called kidney failure, end-stage renal disease, or ESRD. According to the CDC, diabetes is the most common cause of ESRD.
DKD has notable characteristics that distinguish it from other forms of CKD. Patients are often more anemic in DKD than in nondiabetic CKD. Inflammatory inhibitors of erythropoiesis and proteinuria, with losses of iron bound to iron-carrying proteins, have been variably implicated as causative.
Diabetic nephropathy is the leading cause of end-stage chronic kidney disease in most developed countries. Hyperglycemia, hypertension and genetic predisposition are the main risk factors for the development of diabetic nephropathy.
The incorrect portion of the response came as an aside at the end, where it was stated that “it would be redundant to assign codes for both diabetic nephropathy (E11. 21) and diabetic chronic kidney disease (E11. 22), as diabetic chronic kidney disease is a more specific condition.” It is true you wouldn't code both.
So yes, use the appropriate combination codes, being E11. 22, I12. 9 and N18. 3.
Type 2 diabetes mellitus with diabetic nephropathy E11. 21 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM E11. 21 became effective on October 1, 2021.
A collection of symptoms that include severe edema, proteinuria, and hypoalbuminemia; it is indicative of renal dysfunction. A condition characterized by severe proteinuria, greater than 3.5 g/day in an average adult. The substantial loss of protein in the urine results in complications such as hypoproteinemia; generalized edema; hypertension;
The 2022 edition of ICD-10-CM N04.9 became effective on October 1, 2021.
In the next related question, the patient has acute pyelonephritis and nephrolithiasis, and the advice is to use two codes: N10, Acute pyelonephritis, and N 20.0, Calculus of kidney.
If the provider had documented “ESRD due to diabetic nephropathy and hypertension,” the appropriate codes would have been E11.21, Type 2 diabetes with diabetic nephropathy, I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease, and N18.6, End-stage renal disease. It is often difficult to sort out which disease process is the dominant cause, and likely, they both have an impact and share responsibility. In this case, however, the provider linked the ESRD to diabetes and listed hypertension as a separate diagnosis, so I agree with not assuming linkage.
We are instructed to use the code, J18.1, Lobar pneumonia, unspecified organism, only when the provider documents “lobar pneumonia,” typically for consolidation of a lobe, not for patchy infiltrates. Good call.
It is true you wouldn’t code both. Diabetic nephropathy is a specific subset of CKD. It is an advanced renal disease due to microvascular damage from hyperglycemia, manifested by proteinuria. I again refer you to the article referenced above; diabetic kidney disease includes diabetic nephropathy and other parenchymal kidney diseases, ...
E10.29 Type 1 diabetes mellitus with other diabetic ...
E11.618 Type 2 diabetes mellitus with other diabetic ...